The HANDI team collect possible topics from a variety of sources including online evidence summaries (ACCESS and Cochrane databases), suggestions from the Committee members and suggestions posted to the HANDI website.
Committee members choose topics that are relevant to general practice and for which there is existing evidence. This is followed by a search for other systematic reviews and subsequent trials.
Each potential HANDI entry then goes through a 3-stage process before being published.
Stage 1: Assessing the evidence and relevance
The Committee assess the effectiveness of the proposed non-drug intervention in this stage. Individual members present their assessment to the team, using a standard assessment template, followed by general discussion and a voting process. The Committee consider two questions for assessing inclusion in the handbook:
- Is the evidence strong enough?
- Is the intervention relevant to and practical for GPs?
For inclusion in HANDI interventions must be supported by at least two positive good quality Randomised Controlled Trials (RCTs) with patient-relevant outcomes, or one RCT with strong supportive evidence for the causal connection under investigation.
At this first presentation the Committee note issues that need to be considered in drafting the handbook entry.
The RAGCP currently use the NHMRC levels of evidence and in the future we will move to a GRADE process. Criteria for inclusion in HANDI are high; despite looking only at treatments with promising evidence, about half of the proposed interventions based on the criteria above are rejected.
Stage 2: Drafting the HANDI entry
If the evidence is strong and the intervention is relevant to general practice, the intervention is accepted for publication. The Committee works with a medical writer, and also with trial authors and other experts in the type of intervention where possible, to develop a detailed “how to” guide for the use of the non-drug intervention.
The format is similar to that of a drug formulary. It includes indications, contraindications, precautions, adverse effects, availability and description of intervention. It also includes consumer resources
Stage 3: Final review
Once drafted, the entry is reviewed at a subsequent committee meeting prior to finalisation and publication onto the HANDI website.
The committee currently meets 6 times per year, and considers around 4 – 6 new potential entries at each meeting. Each committee meeting is about 3 hours, in which about half of this time is spent discussing the evidence for new possible entries and the other half discussing draft entries that are being developed.